Cerebellar Stroke - Oren Zarif - Cerebellar Stroke

The clinical course of patients with cerebellar stroke varies widely. The symptoms can range from immediate unresponsiveness to coma within hours. Patients may suffer from concurrent brainstem infarction. Amarenco9 has found that massive cerebellar infarction is associated with poorer motor response and deterioration. Despite varying outcomes, it is important to know what to expect. Here are some key considerations in cerebellar stroke.

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The distribution of cerebellar infarcts is not completely clear. MRI and CT scans often show very small infarcts. These lesions are characterized by a low blood flow in the border zone between the two perfusion territories. These microinfarcts are not visible on postmortem brains, but can be detected in vivo using neuroimaging techniques such as high-field strength MRI.

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To make a precise diagnosis of cerebellar stroke, doctors will use a comprehensive history and neurological examination. Imaging tests may be needed to assess for brain bleeding or other injuries. An MRI may be performed first, as this type of scan shows the cerebellum more clearly than a CT scan. Patients will undergo an MRI within a few days after the stroke. This type of scan is a noninvasive way to diagnose cerebellar stroke.

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Although cerebellar stroke accounts for fewer than 2% of all cerebral infarctions, it has a mortality rate of nearly 40%. Additionally, approximately 50% of survivors have long-term deficits due to their stroke. Symptoms include ataxia, vertigo, and headache. Known risk factors include hypertension, cigarette smoking, and diabetes mellitus. These patients may have additional comorbid conditions.

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Cerebellar stroke is distinguished from other types of stroke by the severity of symptoms. Nonspecific neurological symptoms, such as weakness or jerking of the eyes, may be the hallmark of a cerebellar stroke. Symptoms can vary widely, depending on the size of the stroke and where in the cerebellum the injury occurs. Once diagnosed, patients should seek medical attention as soon as possible. If the symptoms become more serious, they may require surgery or long-term treatment.

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Although the location of the infarct does not seem to be associated with neuropsychiatric symptoms, there are several cases where a cerebellar infarct may result in psychosis. The presence of psychosis in patients with a cerebellar stroke converges with recent clinical and neuroimaging studies, suggesting that it is an important factor in these cases. Therefore, it is important to recognize the location of the infarct in a person with a cerebellar stroke.

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The early intervention of a cerebellar stroke may be critical for full recovery. Patients must understand that the recovery time may be long, and they could experience permanent injury. Physical therapy is important for a person with a cerebellar stroke because it enables retraining of the brain to control muscles. Massed practice of physical therapy exercises stimulates the brain and sparks neuroplasticity. This treatment is not a miracle cure, but it can help the patient with daily activities.

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The best way to diagnose a cerebellar stroke is to use a CT scan. This is the gold standard of diagnostic imaging. CT scans can show a cerebellar infarction. DWI can also show a lack of perfusion or signs of tissue injury. If a large vessel occluding, magnetic resonance angiography can help guide endovascular treatment. Other imaging methods, such as unenhanced computed tomography, may occasionally detect a cerebellar infarction. But they are limited by radiopaque bones and their poor sensitivity and specificity.

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Surgical treatment for cerebellar stroke can involve a combination of therapies. In addition to medical treatment, surgical management may include resection of infarcted cerebellar tissue, or brainstem compression. In some cases, repeated imaging may be necessary to identify any progressing brainstem compression. It is important to follow the patient's progress closely until symptoms improve or worsen. In some cases, a ventriculostomy may be sufficient for temporary relief. If progressive brainstem compression is present, craniectomy is the only definitive treatment.

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The underlying causes of cerebellar stroke include blood clots, traumatic brain injury, and high blood pressure. Lifestyle risk factors include hypertension, obesity, elevated cholesterol levels, and smoking. A ruptured brain aneurysm may also cause cerebellar hemorrhagic stroke. Another risk factor for cerebellar stroke is neck trauma. A neck trauma can injure blood vessels in the cerebellum.

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Patients with isolated cerebellar infarctions recover well at 90 days after the stroke, and the recovery is based on the location of the lesion. The outcome of patients with cerebellar stroke depends on the size of the lesion, so further research is needed to investigate the clinical deterioration of these patients. The study team acknowledges the contributions of each of the three authors and notes the strengths and limitations of the study.